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Episode 50

Mental Compulsions Part 2

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On today’s episode of Purely OCD, Kelley Franke, LMFT, and Lauren Rosen, LMFT, pick up where they left off in their discussion of mental compulsions.They define and discuss more sub-types of mental compulsions. They also talk about helpful versus unhelpful thinking through the lens of Acceptance and Commitment Therapy. As always, they answer questions from viewers who tuned in live.

Kelley and Lauren get down and dirty and begin this episode with a discussion on Mental Rehearsal. 

Kelley begins with an explanation (at 2:25)

“Mental rehearsal, folks, is exactly how it sounds. It’s when we’re rehearsing these events and going over ways that it could go and all the different scenarios in which it can go. Like “What if today when I see my daughter, I pick her up this way?” “How will I be, and how will she respond?”

So it’s more of this future rehearsing of events that haven’t and all the different variations, like Choose Your Own Adventure.”

Kelley Franke, LMFT

The two run with the Choose Your Own Adventure metaphor.

(P.S. If you haven’t read one you’re really missing out! Either way, we hope you enjoy this picture of a retro one!)

Lauren: Like Choose Your Own Adventure Books. Oftentimes with mental rehearsal, we go, we pick one, right? For those of us who have read Choose Your Own Adventure books as children, you pick one. You go and then that version of the story ends, and then you come back, and then you choose another route, and another route, and another route. Like the mental rehearsal piece is going to keep going, you can go in so many different directions with Choose your own Adventure books.

Kelley: And honestly, I’m not going to lie. Those books I used to go through, because I wanted to know every single one and it never worked out for me, because I was never satiated. I wanted to keep going with it and see all the different directions.

Lauren: You need to figure out how it could all go. And this is all with the same aim. To get some degree of certainty, to quell the anxiety, and the underlying uneasiness.

This comes up across themes, but the ladies discuss how it shows up particularly in:

• Social Anxiety (e.g. What if I humiliate myself? I better figure out what I’m going to say!)
• Moral Scrupulosity (e.g. What if I act in an offensive way? I better rehearse that scenario so I don’t)
• Contamination OCD (e.g. Now that I’ve touched this, what will I touch next and how will I deal with that? (which sounds an awful lot like tracking that was talked about in Episode 49: Mental Compulsions, Part 1)

Lauren and Kelley turn to the topic of mental checking (at 5:40):

Lauren: When we talk about mental checking, oftentimes that involves going back into your mind and checking your memories of checking. So if you are prone to checking the front door, for instance, to make sure that it’s locked, you might go back and check a memory of having checked the front door just to be sure that you did it.

Kelley: Which also leads to things like false memory, real events, things like that. “Let me go back and check that memory and see if it’s exactly how I remember it.” And also the deeds related to it.

The two then talk Memory Hoarding (at 7:41).

“Memory Hoarding I think about in terms of hoarding items. This is just hoarding memories constantly, and trying to track it all and have this inventory so you can go back and say, ‘Oh, is that exactly how I remember locking the doors?  Feeling that lock feeling.’

Kelley Franke, LMFT

Lauren and Kelley talk about it how mental hoarding can be like the creation of a mental Rolodex. In case you don’t know what a Rolodex is:

Essentially you’re cataloging memories for later reference.

Kelley emphasizes that there’s a lot of overlap with these mental compulsions (at 9:22):

“For those of you who maybe are just joining us for the second part of Mental Compulsions that these are all really loose ways of talking about this. These titles aren’t official titles.   All OCD therapists might talk about these things. They might not be using the exact language. So don’t get too caught up in the actual language.

But it’s more about what these are ideas of what Mental Compulsive Behavior looks like. And this is our queue to recognize it’s compulsive so we can then intervene. It’s just content. Like, ‘Oh, this is Harm OCD,’ or, ‘this is Pedophilia OCD.’ It’s all just bleeding. It’s a mess.  Don’t get stuck in the details trying to label it because it’s irrelevant.”

Kelley Franke, LMFT

Lauren underscores Kelley’s point:

“We’re trying to point out ways in which the brain can be sneaky so that it doesn’t fool you. Like:

‘I see you. I heard about that. Kelley and Lauren were talking about that. I don’t know what it’s called, but it doesn’t matter. I’m still trying to get a certainty by some sort of mental process’ 

Which is why I really love talking about rumination, because it is, in many ways, this big catch-all that you don’t necessarily need to get into the nitty-gritty about.  Just recognizing, ‘Oh, I’m churning this over and over and over.’ It doesn’t matter if I’m churning over and over and over about the future with Mental Rehearsal or the past, with Mental Review or turning over memories.”

Lauren Rosen, LMFT

Next on the mental compulsions chopping block, Compulsive Prayer (at 11:35)

They begin by discussing the difference between prayer and compulsive prayer.

Compulsive Prayer vs Prayer:

“It comes up a lot in Magical Thinking OCD. So if somebody has worry thoughts, like, ‘I just stepped through the doorway and siren started blaring outside. And so now I have to say three Hail Mary’s, and I have to say them perfectly. And I have to be perfect with my meaning and intention behind every word so that my mother doesn’t die.'” 

Lauren Rosen, LMFT

How else do we tell the difference?

Kelley: [Compulsive Prayer is] done to eliminate the anxiety. It’s done with urgency, and there’s this intensity behind it. The content is a little hollow, but the feeling is like if I don’t, something bad will happen.

Lauren: That’s such a good point. It’s simultaneously hollow, but it’s also so focused. It’s not focused on the thing that I think most people want prayer to be focused on.

Kelley: And the rigidity of it. The fact that you would say, “I have to do it. I have to say it perfectly. I have to say it with perfect intention.”Would the average person who’s praying, think like that? Likely not. They’re going to be okay with you missing a couple of words, or being distracted when you’re doing your prayer, or not having it be exactly at 09:00 p.m.. There’s definitely more room.”

Lauren: That’s so true. And I love what you said about that, because it’s like that inflexibility with things is so characteristic of all compulsions, including this one. And also it reminds me of compulsions related to rereading when “I’m not sure that I’m getting the right information out of this. I’m not sure that I’m focused correctly on this. What if I missed something? I need to reread it and try to focus in on every individual word.” [And the more you re-read] the more you lose the plot of the whole meaning and the more that you need to reread.  So it has that kind of flavor to it.

Kelley: You’re “F”ed basically. It’s a trap.

Next, Lauren and Kelley talk about scenario twisting, yet another type of mental compulsion (at 15:25):

“Good old scenario twisting.  It kind of leads into Mental Rehearsal. It’s like “Let me find ways that I can twist potential outcomes.” And it could be from the past, too.

It’s like if last week, when I went on this date with Jimmy, “What if I had said this to him instead of what I said?” “How would the outcome have been?” Or in the future, when I drive this direction, or I choose Exxon instead of Chevron, which they’re all a nightmare, how would the outcome have been?”

Kelley Franke, LMFT

The two then turn to a discussion of self-reassurance (at 16:38):

“I think this one comes up so much in just wanting to go over the information in a way to make yourself feel better about the unknown. But that’s not going to happen because this, that, or the other thing, and whatever story you make up in your mind.

So, for example, if you have POCD, and you’re worried about what you could do to a child, you might say, ‘Well, but I’m a really good aunt, and I’m really caring, and I’ve never harmed my niece, so I would never harm anyone else.’ That’s an example of reassuring yourself.

Also it makes sense to go over the rationality once, and I think that initial reality check isn’t the same as Self  Reassurance. It’s about going, “Okay, well, what makes sense here?” But beyond that, if we continue to go back over and over that information, it becomes a real problem.”

Lauren Rosen, LMFT:

Kelley elaborates (at 18:10)

“It’s anything that’s in excess to what the average person would be doing. So if we’re starting with Cognitive Restructuring, and we’re saying, “Well, this is likely an OCD thought; it fits all the components.

It feels urgent that you’re engaging in this compulsive behavior. We want to re-frame it, and call it for what it is, but, at the same time, we also have to accept that, “Oh, well, maybe it isn’t OCD.”  “It’s possible it isn’t.” Because saying,  “This is just OCD” is a really common Self Reassurance. Like you said, in small tidbits, it’s good. It’s when it becomes really just over the top, and it’s done to try to neutralize it and have total certainty, that this must be true or false.”

Kelley Franke, LMFT

Lauren talks a little bit more about how saying “this is OCD” can turn into self-reassurance.

“That example is so important.  The reassuring yourself that it’s OCD, because it happens so much for people.  “Oh, well, my thoughts don’t necessarily mean anything.” And they’re quote, unquote OCD thoughts, and I can just ignore them and it’s safe.” And then it’s like, ‘But what if it’s not safe?”  The problem is that if we say “It’s safe, we have certainty.” We still have to leave in there the potential that it’s not safe.

And the idea of an OCD thought from that standpoint, is like a false dichotomy. It’s to say that there’s “OCD” thoughts and then there are “normal” thoughts. Thoughts are thoughts, man.

– Lauren Rosen, LMFT

At 21:25, they dive into Q&A.

Question: Mental review always leading to a catastrophe for me.  My mind goes to the worst outcome.

Kelley: Some people actually use that word Catastrophic Mental Review. I think that’s kind of the example of how all this works. It ends up in catastrophe. Generally Mental Review doesn’t end in a positive. Unless you’re doing Thought Replacement where you’re replacing the bad with the good, but that ends up backfiring anyway.

Lauren: Because then you’re going to get another bad thought.

Kelley: It’s like you’re prepping yourself for the worst for sure.

Lauren: And it is sort of a safety mechanism. If I can make sure that I have all of the information in place so that, if the worst case scenario comes, I’m all prepared for it and ready to respond. But also I won’t be too disappointed. I can somehow safeguard myself from future negative feelings.  But it never ends in daffodils and bunnies.

Question: How do you know if it’s mental compulsion or just a fact?

Kelley: I would suggest going to watch our first part, Part One on mental compulsion, because what we talked about in that one is pulling apart the Obsession versus the Compulsion.  Mental Compulsive Behavior is not about fact. It’s about you attempting to get to some “fact” that hasn’t yet occurred, or something that already did happen, and we’re trying to negate it or figure it out in some way. And that’s also impossible.

Lauren: The fear is that the obsession is a fact. It’s important to remember that thoughts are like words in a book. The book can be fiction or nonfiction, but they’re still just words.  That’s the same thing with thoughts. It could be factual, but it could not be. And all of it is just a story, ultimately. All this is a tale, the Tale of the Daffodils and the Bunny.

Kelley says, ‘All we have is the present moment. It is a gift. That’s why it’s called the present.”

At 25:00, the two talk about an example to demonstrate:

Lauren: In The Happiness Trap, by Russ Harris, he talks about the example of a woman who is single in her thirties, and she’s really disappointed it’s her birthday. She wants to be with somebody, but she keeps churning about the fact that she’s single. And the idea is, Okay, there is a fact; she is single, and she also would prefer not to be.  That’s her preference. But that fact. is it’s not helpful to spend a lot of time reviewing that fact, because one way or another, if she wants to find somebody, reviewing the fact that she’s single and creating the horrible narrative of how she’s going to be single and alone forever in her head, is definitely not going to help in the quest to not be single.

Kelley: It’s not problem solving.” 

Lauren: I’m glad that you said problem solving, because ultimately this is all problem solving gone awry. That’s what mental compulsions and compulsions, as a general rule, are.

Question: When I have a sensation, I automatically try to figure out if I have cancer.

“So this is exactly what we’re talking about.  This is not helpful. You thinking about it, or you trying to figure it out isn’t making you have cancer or not have cancer? You either have it or you don’t. And that’s a scary reality to live with, but it’s the only reality we have.

And I picked this one on purpose, because it’s content might border on Generalized Anxiety and Health Anxiety or OCD, it kind of hits all of them, which is like, ‘Oh, you have permission now to ruminate on this, because most people would ruminate on a thought like that if they were given some set of symptoms, or a doctor alluded to something, or they had a bodily sensation, and we’re not going to figure it out in our mind. We have to let a doctor figure that out.’

Kelley Franke, LMFT

The two discuss the futility of trying to figure things out internally (at 28:25),

Lauren: I’ve tried to figure out a lot in my mind about things that can’t be figured out in there. It doesn’t work out very well. I can speak from personal experience.  It turns out I can’t diagnose myself in my brain.”

Kelley: I tried to do that for nine months while I was pregnant, and I ended up in ICU for a week. So not thinking about what was really going on, is that crazy?

Lauren: That’s the funny thing, we think that we are so capable of figuring all this stuff out when there are way too many factors. I went to see [the move Everything, Everywhere, All at Once], and it was great. The movie is basically about a woman in the multiverse. You see all of these different universes, and in one of the universes, they have hot dogs instead of fingers. So their fingers are like hot dogs.  I think the point is that you can’t imagine all of the ways that things could play out. Right?  I’ve thought about so much stupid stuff over the years. Never once had I thought, “What if my fingers were hot dogs?” Not ever until I saw this movie. If you think that you can figure out everything, you can’t, you’re wrong.

Lauren and Kelley discuss navigating the difference between problem-solving and mental compulsions:

Kelley: Now if you have to move it’s like, “Okay, well, I roughly know the things that have to get done, and these are the steps I’m going to take to get them done. That’s problem solving. That’s not Mental Compulsive Behavior. But it can tip. It can still tip.

Lauren: It’s like the rigidity, the excessiveness, the quality of it, and the effectiveness of it. If it’s not doing anything, if you’re not getting any more marrow out of going over it for the 15th time, you might want to consider doing something else instead. Again, speaking from personal experience as well as professional.   I’m not casting aspersions here. I get it. It’s hard. It’s really hard when you’re in it and the pull to do it is intense. Stay strong out there, warriors. Stay strong. Fight the good fight!

At the end of the episode, Lauren and Kelley announce that next week they have a special guest joining them: Jenna Overbaugh – a clinician with NOCD who advocates on Instagram.

They also share that, the following week, they will continue with their discussion on Mental Compulsions and how to deal with Mental Compulsions.

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